OPEIU Local 30 Membership Form

I, the undersigned, make application for admission to membership in the Office and Professional Employees International Union, AFL-CIO, Local 30 to serve as my chosen and authorized collective bargaining representative on matters relating to wages, benefits, hours and other working conditions of employment.

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Full Name
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First Name Middle Name Last Name

Employee ID

Address
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Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Personal E-mail
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Home Phone

Work Phone

Cell Phone
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By providing your cell phone number, you understand that OPEIU Local 30 may send you automated calls and/or text messages on your cell phone on a periodic basis. OPEIU Local 30 will never charge for alerts, but message and data rates may apply. You can text HELP for more information and STOP to stop receiving messages to 97779 at any time.

I agree to receive automated calls and/or messages I do not wish to receive automated calls and/or messages

Gender

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Birth Date (for identification purposes)

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Where Employed
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Hire Date

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Job Title

Hours

Full-Time Part-Time On-Call

Have you been a member of any Union before?

Yes No

If yes, what Union?

lt is understood that upon acceptance of this application, I hereby subscribe to the following obligation: I pledge my honor to faithfully comply with the Constitution Laws and all amendments thereto of Office & Professional Employees International Union Local 30 and of the International Union. I further promise not to divulge or make public any of the private proceedings of this Union to faithfully perform all the duties assigned to me to the best of my ability and skill, to so conduct myself at all times as not to bring reproach upon my Union and at all times to bear true and faithful allegiance to the Office and Professional Employees International Union of the American Federation of Labor and Congress of Industrial Organizations.

I hereby assign to Office and Professional Employees International Union, Local 30 from any wages earned or to be earned by me as your employee such sums as the said Local Union may certify as due and owing from me as membership dues or nonmember fees, and initiation fees, reinstatement fees, and other monies due and owing to the Union in such sums as may be established from time to time by said Local Union. I authorize and direct you to deduct such amounts from my pay and to remit same to the Union at such times and in such manner as may be determined by the Union at any time while this authorization is in effect. This assignment, authorization, and direction shall be irrevocable for the period of one (1) year from the date of my signature below, or until the termination of the collective agreement between the Employer and the Union which is in force at the time of the execution of this authorization, whichever occurs sooner; and I agree and direct that this assignment, authorization and direction shall be automatically renewed, and shall be irrevocable for successive periods of one (1) year or for the remaining period of such oollective agreement and each succeeding applicable collective agreement between the Employer and the Union, whichever shall be shorter, unless written notice from me is received by both the Employer and the Union, by certified U.S. mail, not more than twenty (20) days and not less then ten (10) days prior to either the expiration of a period of one (1) year, or the termination of the applicable collective agreement between the Employer and the Union, whichever occurs sooner. This authorization for check-off of dues, fees, and other monies due and owing to the Union is made voluntarily and pursuant to the provisions of Section 302 (c) of the Labor Management Act of 1947.

Signature
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VOLUNTARY DEDUCTIONS FOR THE J.B. MOSS VOICE OF THE ELECTORATE (VOTE) FUND

Signature for VOLUNTARY DEDUCTIONS FOR THE J.B. MOSS VOICE OF THE ELECTORATE (VOTE) FUND
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